So you’ve decided you need help because you
can’t stop drinking or using drugs on your own. Good for you! Now the next major
decision to make is to decide between getting help on an outpatient
basis or getting residential care (rehab).

This is an important choice and by getting it right from the
start you improve your odds of success. Given this, you probably shouldn't make the decision on your own. It makes good sense to find a professional who can assess you and make a
treatment recommendation that’s appropriate to your needs, location and
situation.

To find someone who can perform this service:

Ask your doctor for a referral

Get in touch with an addiction counselor

Get in touch with a local addiction treatment provider (they
will have assessment professionals on staff or can refer you to a local
option).

Though you might think it’s primarily just a decision
between getting outpatient treatment or rehab, there are actually many
different treatment options, at varying intensities, and you might benefit most
from a combination of more than one type of intervention. Different treatment
options that an assessment professional might recommend include:

Outpatient Options

Getting individual addiction counseling

Getting into an ambulatory detoxification program (where you
check-in daily with a doctor and get appropriate medications, but spend
most of the detox period at home.)

Joining an outpatient addiction treatment program or an
intensive outpatient addiction treatment program. An outpatient program usually
provides one or two evening or weekend group or individual therapy sessions per
week, and may last for a year or longer. An intensive outpatient program
typically provides between 10 and 20 hours of group and individual therapy per
week.1

Joining an all-day addiction treatment program (this would
have a very similar daily schedule to a residential treatment program, but you
would go home each night to sleep.)

Joining a local therapy group

Community mutual self-help group, like AA/NA or SMART
Recovery meetings

Do You Need Rehab?

Unfortunately, this isn’t an easy question to answer.

Professionals rarely make treatment decisions
based on a single determining factor, they normally consider a range of mental,
physical, emotional, historical and environmental factors and make a placement
decision based on this big-picture assessment.

To help you decide whether residential or outpatient
treatment makes most sense, consider the following assessment variables.

Detox variables

People withdrawing from alcohol or benzodiazepines
(benzodiazepines are rarely withdrawn cold-turkey) may need residential care
during detox. People withdrawing from opiates who are expected to have
complicated withdrawals (for example those with poly-drug dependence or other
serious health conditions) may also require residential treatment.

People withdrawing from drugs like marijuana or cocaine may
not require residential detoxification.

Are you addicted or abusing? People who are substance
dependent (addicted) tend to require more intensive treatment than people who
abuse drugs or alcohol, but are not yet dependent. In most cases, substance abuse only is best
treated on an outpatient basis, while depending on the severity, substance
dependence can be treated in an intensive outpatient program, a day treatment
program or a residential treatment program.

Are you addicted to more than one drug? The more substances
you are dependent on the more complicated the treatment. Someone who is
addicted to cocaine and alcohol is more likely to require residential treatment
than someone addicted to only one of those substances.

Do you have co-occurring mental illness? People with active
addiction and symptomatic mental illness are more likely to require residential
treatment and more intensive integrated treatment.

Do you have a serious physical illness that may get worse
when you stop using drugs or alcohol? Although reducing your drug or alcohol
use will almost certainly improve your long-term health, the short-term process
of getting to abstinence can create medical complications - especially for
people with diseases like hepatitis C, cirrhosis, HIV and others.

Have you ever tried outpatient treatment before? You want to
find the least intrusive level of care that gets you the results you need. If
you haven’t yet tried far less costly and disruptive outpatient treatment, it
may make sense to start with this and see if it helps. If you’ve tried
outpatient before, especially recently, and not found success, this indicates a
need for a higher intensity level of care, like residential.

Does your home situation help or hinder your recovery
efforts? If you’ve got supportive people in your life and a safe, sober and
stable home situation, then you’re more likely to have success with outpatient
treatment than you would if living without sober support or if living in an
unstable environment and exposed to temptation in the home.

Can you get away from work or school for a month or longer?
While it’s rarely easy for anyone to find a ‘free’ month for treatment, in some
situations, it’s prohibitively hard. For example, if you’ll lose a good job to
go to rehab, then maybe you need to try outpatient first. Remember though, for
most people it’s getting insufficient treatment that ultimately leads to job loss.

Can you get to outpatient sessions? If someone needed
intensive outpatient or day-treatment but lacked reliable transportation to
sessions or lived too far away for a daily commute, that person might be better
off in a residential program – or in a day-treatment program and sober-living
environment.

Will you actually go to outpatient sessions? If you know that on your
own you’ll blow off meetings and therapy sessions, then you may need the
structure and support of a residential program.

Do language or cultural concerns preclude residential care?
It’s important to think about cultural fit and language accessibility. For
example, if a person speaks only Korean and residential services are available
only in English or Spanish, that person would need to either travel to a distant
language accessible facility or get less intensive counseling from a Korean
speaking counselor.

If residential treatment is possibly indicated, can you
afford it or access low-cost care? In an ideal world everyone would get exactly
what they need – in this world, things don’t always go so smoothly. If
residential treatment is indicated, can you afford the out of pocket costs and
or will your insurer fund residential care? If not, are there local public or
charitable options worth considering and are their availability issues or
waiting lists to consider?

Do your answers to the questions above mostly point you toward rehab, or toward an outpatient option as a best starting point?

Rehab or Outpatient - Which Is Better?

Not which is best – which is best for you!

Although you might feel that more intensive treatment, like
rehab, gives you a better chance at success, no legitimate
treatment is really ‘better’ than another, it just depends on your needs.

Rehab provides you with the safety and structure and time
you need to get past the really difficult first few weeks of abstinence. Since
it’s an intensive all-day program, you can learn a lot about the disease and learn
many effective coping strategies within a short period of time.

Outpatient treatment isn’t nearly as disruptive. You can
still go to school or work while in treatment and the costs are generally a
fraction of residential treatment. Additionally, by staying at home and in ‘the
real world’ you can put all the coping strategies and tools you learn into
immediate practice.

A Starting Point Isn’t an Ending Point

Remember – treatment and recovery aren’t things that happen
on a neat and tidy 28 day timeline. Recovery lasts a lifetime, the brain
changes of addiction are lasting or permanent and you may need different types
of interventions at different periods, as your needs change.

Ideally, your treatment experience changes as your needs
change. When you start off in an intensive outpatient program and do well, it
makes sense, after a while, to step down to a less intrusive form of treatment,
such as a weekly counseling session.

On the other hand, if you’re not making sufficient progress
at one level, it makes just as much sense to intensify treatment to a level
that meets your needs. If an intensive outpatient program does not lead to
significant improvements, this doesn’t mean that treatment doesn’t work, it
just means you need more intensive care, such as the treatment you’d get in a
day treatment program or a residential drug or alcohol rehab.

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